UPDATE: NASG Paper Selected as a Top Global Emergency Medicine Article of 2012
The UCSF Safe Motherhood Program is proud to announce the publication of Comorbidities and Lack of Blood Transfusion May Negatively Affect Maternal Outcomes of Women with Obstetric Hemorrhage Treated with NASG in the PLOS ONE Open Access Journal.
This paper was co-authored by Dr. Alison El-Ayadi, Elizabeth Butrick, MSW/MPH, and Professor Suellen Miller of the UCSF Safe Motherhood Program, Bixby Center, Department of Ob/Gyn & Reproductive Sciences; Sarah Raifman, MPH, of the Harvard School of Public Health's Department of Global Health and Population; Dr. Farouk Jega and Yemisi Ojo of Pathfinder International; and Professor Stacie Geller, University of Illinois Chicago School of Medicine, Department of Ob/Gyn.
The paper outlines findings from data collected on 1,149 women who received the NASG for hypovolemic shock due to obstetric hemorrhage at 50 facilities in seven states in Nigeria between 2007 and 2012. The NASG was implemented as part of Pathfinder International's Clinical and Community Action to Address Postpartum Hemorrhage Project in Nigeria.
Data were collected on every woman in severe shock who received the NASG. In analysis, characteristics were compared between women who survived with NASG and women who did not survive with NASG. The mortality among these severely ill women was 17.5%. Death in the NASG was strongly associated with a woman having a comorbidity, such as anemia, eclampsia/preeclampsia, or sepsis. Likewise, a woman carrying a dead fetus or having a macerated stillbirth was more likely to die, most likely from coagulation problems. Women who did not receive a blood transfusion were nearly four times more likely to die than women who did.
The report is the first to be published on the use of the NASG outside of clinical trials and was produced to describe the real-world experience of using the NASG. The findings reinforce and demonstrate many of the UCSF's Safe Motherhood Program's and Pathfinder's hypotheses about the NASG:
1. Use of the NASG reduced mortality among women in hypovolemic shock due to obstetric causes when used in real world settings.
2. The NASG is not a replacement for blood transfusions or definitive care. It is a first-aid device that will help overcome delays in the system. A Continuum of Care Approach (from prevention to definitive treatment) is necessary for optimum maternal health outcomes.
3. A staff well-trained to handle complicated emergency obstetrical care should be looking not only for hemorrhage, but also for comorbidities that might need other treatments, particularly eclampsia and sepsis.
4. Well-trained staff should recognize and manage a woman carrying a dead fetus rapidly before coagulation problems develop.
5. NASG use in real-world settings allows for evaluation and building of the knowledge base without the need to conduct major epidemiological trials.
These findings underscore not only the effectiveness of the NASG, but the need for multi-system assessment and a comprehensive approach to the treatment of women with pregnancy complications.
The complete paper is available at the PLOS ONE website.
The Safe Motherhood Program is proud to announce that "Nurses in Low Resource Settings Save Mothers' Lives with Non-Pneumatic Anti-Shock Garment", published in American Journal of Maternal Child Nursing in 2012, has been selected for inclusion in "Global Emergency Medicine: A Review of the Literature From 2012". The paper was coauthored by Dr. Farah Kausar, Jessica L. Morris, Elizabeth Butrick, and Professor Suellen Miller of the Safe Motherhood Program, Dept. of Ob/Gyn, UCSF; Professor Mohamed Fathalla of the Dept. of Ob/Gyn, Assuit University Women's Health Center, Assuit, Eygpt; Professor Oladosu Ojengbede, University Teaching College, Ibadan, Nigeria; Professor Adetokunbo Fabamwo, Lagos State University College of Medicine, Lagos, Nigeria; Dr. Mohammed Mourad-Youssif, El Galaa Maternity Teaching Hospital, Cairo, Egypt; Imran O. Morhason-Bello, University College Hospital, Ibadan, Nigeria; Hadiza Galadanci, Dept. of Ob/Gyn, Aminu Kano Teaching Hospital, Kano, Nigeria; and Dr. David Nsima, Dept. of Ob/Gyn, Katsina General Hospital, Katsina, Nigeria.
The paper examined data collected on 578 postpartum women with hypovolemic shock in two referral facilities in Egypt and four referral facilities in Nigeria during a pre-intervention phase and an NASG-intervention phase. Women with hemorrhage and shock in both phases were treated with the same evidence-based protocols for management of hypovolemic shock and hemorrhage, but women in the NASG-intervention phase were also placed in NASG by trained physicians, nurses, and nurse-midwives. Women in the NASG-intervention phase had 50% lower blood loss, reduced rates of hysterectomy, and lower mortality (2.3% compared to 8.5% among the pre-intervention phase women). This paper provided evidence that with training, nurses and nurse-midwives in low-resource settings can stabilize hemorrhaging women and improve their health outcomes using the NASG.
This year, 4818 articles were sourced from the published and grey literature in multiple languages and screened by the Editorial Board of the Global Emergency Medicine Literature Review. Ours was one of only twenty-eight selected for inclusion in this year's review of papers "of the highest quality which have specific relevance to the various domains of global emergency medicine, including: emergency medicine development, disaster and humanitarian response, and emergency care in resource-limited settings". We are honored by this high-level recognition of the NASG's contribution to emergency obstetric care in low-resource settings and hope that inclusion in this review will encourage further adoption of the NASG.
"Global Emergency Medicine: A Review of the Literature from 2012" is available here.